Comple mpleting t ng the he Subst Substanc ance Use se Di - - PowerPoint PPT Presentation

Comple mpleting t ng the he Subst Substanc ance Use se Di Diso sorde der C r Continuum nuum

• f C

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Health First Colorado Jalyn I n Inga ngalls a s and nd S Sara Schmi hmitt

Stakeh ehold lder er M Meet eeting

June 2019

Toda

• day’s A

Age genda nda

• Welcome
• Review of work to date and previous stakeholder

communications

• Summary of Substance Use Disorder (SUD) Waiver

Proposal

• Next Steps for Stakeholder Engagement

Goa

• als for T
• r Toda
• day’s Meeting

ng

• Provide background on the waiver and work to date.
• Review and discuss content of the waiver application.
• Identify next steps in the waiver submission process.

Bef efore W e We e Get et Star arted ed

• Please silence cell phones.
• Share your unique perspective.
• Honor the public space.
• State your headline first so that everyone can participate.
• Write down anything that you were unable to say during

the meeting. (Email to CHI.)

Waiver r reca cap

• HB18-1136
• Previous stakeholder meetings: November 2018 and May

2019

• Waiver components: application, implementation plan,

monitoring and evaluation

• Implementation milestones
• First draft of waiver complete

Waiver Timeline

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1. Access to critical levels of care 2. Evidence-based, S UD-specific patient placement criteria 3. Use of nationally recognized standards to set provider qualifications 4. S ufficient provider capacity, including medication assisted treatment 5. Treatment and prevention strategies to address opioid abuse 6. Improved care coordination and transitions

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Waiver Demonstration Milestones

Colorado’s Medicaid Section 1115 Substance Use Disorder Waiver Proposal

Presented by: Kim McConnell, PhD ACC S UD Administrator

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June 2019

• S

ection 1115 waiver demonstrations provide states with opportunities to test new approaches in Medicaid programs

• S

UD waiver initiative is a response to opioid epidemic

• Twenty-two states have approved S

UD waivers; six more pending

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Medicaid Section 1115 Waivers

Complete the Colorado S UD continuum of care in

• rder to improve health outcomes, promote long-

term recovery, and reduce overdose deaths.

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Waiver Goal

Add inpatient and residential S UD treatment, including WM services, for Medicaid members who need this level of care Ensure that members receive a comprehensive assessment and are placed in the appropriate level of care Improve the availability of MAT to promote long-term recovery

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Waiver Objectives

New services will be open to all Medicaid members with a covered S UD diagnosis and who meet medical necessity

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Eligibility for Waiver Services

ASAM Level of Care Designations

Services defined by the American Society of Addiction Medicine (ASAM)

• ASAM Level 3.1: Clinically Managed Low-Intensity Residential S

ervices

• ASAM Level 3.3: Clinically Managed Population-S

pecific High-Intensity Residential S ervices

• ASAM Level 3.5: Clinically Managed High-Intensity Residential

S ervices

• ASAM Level 3.7: Medically Monitored Intensive Inpatient S

ervices

• ASAM Level 3.7 WM: Medically Managed Inpatient Withdrawal Management

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Proposed Expanded Services

The S UD continuum of services will be managed by the RAE’ s. RAE’ s will receive a capitation payment to provide these services.

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Delivery System

• CMS requires Section 1115 waivers to be “ budget neutral,”

meaning that services provided under demonstration can cost no more to the federal government that what would have been spent absent the waiver

• For Colorado, budget neutrality will be demonstrated by

proving that reductions in ED visits and repeated inpatient hospitalizations will offset the cost of new services

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Financing

• The department is drafting and refining the waiver application and developing

budget proj ections

• Prior to CMS

submission, the Department will:

• Conduct a series of stakeholder meetings, including two formal public hearings
• Conduct Tribal consultation
• Post full application for 30-day public review and comment
• Goal is to submit waiver proposal to CMS

in Fall 2019

• Go live date for waivered services S

ummer 2020

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Next Steps in Waiver Submission Process

• Correspond with CMS

during the waiver approval process

• CMS

will draft S pecial Terms and Conditions (S TC’ s)

• S

ubmission of the Implementation Plan

• Discussion and approval of implementation plan
• Development and submission of the monitoring and evaluation plans
• Procurement of 3rd party evaluation contractor

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Post-submission waiver activities

• S

UD treatment system capacity assessment and collaboration for expansion

• Interchange system changes
• Contract amendments
• Collaboration with OBH to bring licensure requirements into alignment with AS

AM criteria

• Provider and RAE training to ensure consistency in utilization of AS

AM criteria and patient placement decision making

• Planning for improved care coordination and transitions between levels of care

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Planned implementation activities

Questions?

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Contact

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Kim McConnell, PhD ACC S UD Administrator Kim.mcconnell@ state.co.us S hingo Ishida ACC S UD Benefit S pecialist S hingo.Ishida@ state.co.us

Disc iscussio ssion Qu Questio stions

• What are your thoughts on the waiver services that will be

introduced?

• What considerations would you like us to have in mind as

we move into implementation of the waiver next year?

Thank You!

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